A new oral triazole antifungal, SCH 39304, was administered to 54 pati
ents with progressive infections due to Coccidioides immitis from six
collaborating centers. Patients were grouped according to site of infe
ction including chronic pulmonary (25), bone/joint (17) and skin/soft
tissue (12). The median age was 40 years; 83% were male, 52% white, 13
% HIV-infected and 35% had failed previous therapy. The majority of pa
tients were treated with either 100 mg or 200 mg day(-1). One patient
on renal dialysis received 300 mg day(-1). Baseline abnormalities were
reassessed for evidence of efficacy every 4 months and expressed in a
standardized scoring system. Cumulative overall response rates at 4,
8 and 12 months were 7%, 36% and 66% respectively. Twelve month respon
se rates by disease were 77% (pulmonary), 62% (skin/soft tissue) and 3
1% (bone/joint). Fifteen patients failed therapy although seven of the
se were still on treatment when the study was discontinued. Two failed
due to toxicity. Possible symptoms or signs of toxicity occurred in 2
4 (44%) patients and were generally mild. SCH 39304 is an effective an
d well tolerated therapy for progressive forms of coccidioidomycosis.